2. GROWTH AND DEVELOPMENT 生长发育 上海交通大学医学院附属上海儿童医学中心 发育行为儿科 (developmental and behavioral pediatrics) 章依文 Zhangyiwen@hotmail.com

3. Normal or Abnormal? 1. 8 month, boy, head circumference 43.1cm ， microcephaly ？ 2. 9 month, girl ， no first tooth 3. 15 month, girl ， weight 13.2kg ， obesity ？ 4. 12 month, boy ， can not sit alone   5. 9 month baby shows no interests and  attention in playing beads. Why?

4. How Old?

5. REGULAR PATTERN OF GROWTH AND DEVELOPMENT A continuous process Different rate of development in various systems General pattern Individual variance

6. Different rate of development in various systems

7. FACTORS OF GROWTH AND DEVELOPMENT Genetics Gender Endocrine Pregnant condition Nutrition Living environment Diseases environmentgenetics +

9. PHYSICAL GROWTH birth weight ≌ 3kg W(kg)= birth weight (kg)+month×0.7 (kg) W(kg)=6 (kg)+month×0.25 （ kg ） W(kg)=yrs ×2 (kg)+7 or 8 （ kg ） weight newborn 1 to 6 mon 7 to 12 mon 2 to 12 yrs

10. PHYSICAL GROWTH Height newborn 0-1yr 2-12yrs 50cm 75cm H (cm)= yrs×7+70 (cm ） 1-2yr 85cm

11. PHYSICAL GROWTH 1yr newborn 5yr 2yr Head circumference (HC) 34cm 46cm 48cm 50cm

12. PHYSICAL GROWTH Chest circumference (CC) Newborn 32cm 1yr 46cm CC=HC

13. Anterior fontannel PHYSICAL GROWTH  Skeleton development Vertebral column 1~1.5 yr closure Ossification center Bone age

14. PHYSICAL GROWTH First tooth Deciduous teeth 20 30mon 6-10mon Teeth development

15. ASSESSMENT OF GROWTH Mean (X) ＆ Standard (SD) X  2SD Normal distribution X  2SD ±1SD +2SD +3SD 68.3% 95.4% 99.7%

16. ASSESSMENT OF GROWTH Percentile P 3 -P 97 Growth chart Multiple indicators Height for age Weight for age Weight for height Zscore ±2±2

17. Growth Curve         

18. NEURO-PSYCHOLOGICAL DEVELOPMENT Sensation and perception vision 3-4yr 1yr Newborn 6yr 3mon 20cm 180°level 3m 0.7 1.0

19. NEURO-PSYCHOLOGICAL DEVELOPMENT Sensation and perception hearing Newborn 3mon 1yr 2yr 4yr Hearing Turning head to sound Knowing his/her name Following simple direction Hearing mature

20. NEURO-PSYCHOLOGICAL DEVELOPMENT Motor Gross motor 3mon 6mon 9mon 15mon Lift head Sitting Creep ＆ Standing with support Walk alone

21. Lift head SittingCrawing

22. StandingWalk Jump Run

23. NEURO-PSYCHOLOGICAL DEVELOPMENT Fine motor 3mon 6mon 12mon 10mon Grasp object Transfer object Thumb-finger grasp Release cube Motor

25. NEURO-PSYCHOLOGICAL DEVELOPMENT Language age receptiveexpressive 6m NameBabble 12m Familiar object name Pharases Simple needs Repeat sound “ba ba” /“ma ma” 15m ~18m Body part Following simple direction Pointing 15~20 words 24m People/object Pictures Name/object/pictures 300 words 36m 2~3directions sex identity Sentences More words 48m Differenciate colors Following 2~3 directions Telling stories Describing things

27. NEURO-PSYCHOLOGICAL DEVELOPMENT  Thinking  Imagination  Will  Emotion  Personality  Personal-social behavior

28. ASSESSMENT AND BEHAVIORAL DEVELOPMENT  Intelligence Abilities of recognizing the world and dealing with the environmental change  Intelligent quotient (IQ)  Development quotient (DQ)

29. ASSESSMENT AND BEHAVIORAL DEVELOPMENT Psychometry Visual-space orientation Tempory-order Memory Speech language Single developmental screening tests

30. ASSESSMENT AND BEHAVIORAL DEVELOPMENT Denver Developmental Screening Test,DDST Drawing-a-man test Peabody Picture Vocabulary Test,PPVT Abilities tests Screening tests Psychometry

31. ASSESSMENT AND BEHAVIORAL DEVELOPMENT Psychometry Bayley Infant Development Test Gesell Development Test WPPSI WISC-R SM Abilities test Diagnostic tests

32. DIVIATION OF GROWTH Weight Height Head circumference Overweight >2SD or 97 Percentile Underweight <2SD or 3 Percentile Tall status Stunt

33. PSYCHOLOGICAL DISORDER Developmental-behavioral problems Learning disorders Speech and language disorders Mental retardation Breath holding Biting thumb Enuresis Defiance Lying Temper tantrums Sleep disorders

34. Summary Regular pattern of growth and development Physical growth and assessment Neuor-psychological development and assessment

35. Normal or Abnormal? 1. 8 month, boy, head circumference 43.1cm ， microcephaly ？ 2. 9 month, girl ， no first tooth 3. 15 month, girl ， weight 13.2kg ， obesity ？ 4. 12 month, boy ， can not sit alone   5. 9 month baby shows no interests and  attention in playing beads. Why?